Obesity in a forensic and rehabilitation psychiatric service: a missed opportunity?

DOIhttps://doi.org/10.1108/JFP-03-2017-0007
Pages269-277
Date13 November 2017
Published date13 November 2017
AuthorMark Huthwaite,Jane Elmslie,Susanna Every-Palmer,Eve Grant,Sarah E. Romans
Subject MatterHealth & social care,Criminology & forensic psychology,Forensic practice,Sociology,Sociology of crime & law,Law enforcement/correctional,Public policy & environmental management,Policing,Criminal justice
Obesity in a forensic and rehabilitation
psychiatric service: a missed opportunity?
Mark Huthwaite, Jane Elmslie, Susanna Every-Palmer, Eve Grant and Sarah E. Romans
Abstract
Purpose The purpose of this paper is to study weight changes during psychiatric hospitalization, so as to
identify obesogenicfeatures in a mixed ( forensic and rehabilitation) inpatient service.
Design/methodology/approach An observational study of psychiatric inpatients, gathe ring
sociodemographic, clinical, weight, dietary and sleep information and an actigraphic assessment.
Findings A total of 51 patients, aged 19-68, 40 males, participated at a median of 13 months after their
admission. When studied, only 6 percent had a healthy weight, 20 percent were overweight and three
quarters (74 percent) were obese. The mean Body Mass Index (BMI) was 35.3 (SD: 8.1). At admission, only
three patients (8.3 percent) had healthy BMIs and over the course of their hospital stay, 47 percent gained
further weight. A high proportion was physically inactive and half slept more than nine hours a day.
Participants received high calorie diets and half (53 percent) smoked cigarettes.
Practical implications Although antipsychotic medication is known to cause weight gain, this should not
be seen in isolation when attempting to explain psychiatric inpatient obesity. An inpatient admission is an
opportunity to provide a healthier eating environment, health education and assertively promote less
sedentary behavior and healthier sleep habits.
Social implications Obesity adds to the burden of this already significantly disadvantaged group of
patients.
Originality/value The results confirm earli er research showing that forensic a nd rehabilitation
psychiatric inpatients as a group are obese, gain weight while in hospital and often smoke. The authors
add data demonstrating that they are often physically inactive, sleep excessively and consume
an unhealthy diet despite the provision of health focused interventions as an integral part of their
inpatient program.
Keywords Obesity, Forensic, Psychotropic medication, Activity, Sleep, Psychiatry inpatient
Paper type Research paper
Introduction
Obesity, inactivity and poor diet are associated with numerous disease states and premature
mortality in people with psychiatric disorder ( Janney et al., 2013; Ratliff et al., 2012; Vancampfort
et al., 2011; Manu et al., 2015). Obesity is common in-patients with both mood disorders and
with non-affective psychoses such as schizophrenia especially inpatients (Elmslie et al., 2000;
Papanastasiou, 2012; Faulkner et al., 2009; Levine et al., 2001; Haw and Rowell, 2011).
Some review articles posit a shared pathophysiology between obesity and psychiatric disorders
(Elman et al., 2006; Lopresti and Drummond, 2013). Investigating the relationship between
individual antipsychotic medications and obesity (Allison et al., 1999; Correll et al., 2011) misses
the point that patients have often been on several agents sequentially.
Patients with schizophrenia have low physical activity increasing the risk of weight gain and
metabolic disorders (Wichniak et al., 2011; Daumit et al., 2005), and impaired health quality of life
(Vancampfort et al., 2011).
There has been little published research on weight gain in psychiatric inpatient settings; we found
publications from two groups only, both in the UK (Cormac, 2005; Haw and Rowell, 2011;
Haw and Stubbs, 2011).
Received 12 March 2017
Revised 25 May 2017
10 August 2017
Accepted 10 August 2017
Mark Huthwaite is a Senior
Lecturer at the Department of
Psychological Medicine,
University of Otago, Wellington,
New Zealand.
Jane Elmslie is a Research
Fellow at the Department of
Psychological Medicine,
University of Otago,
Christchurch, New Zealand.
Susanna Every-Palmer is a
Senior Lecturer at the
Department of Psychological
Medicine, University of Otago,
Wellington, New Zealand; and
is also based at Capital and
Coast District Health Board,
Mental Health and Addiction
Services, Wellington, New
Zealand.
Eve Grant is based at Capital
and Coast District Health
Board, Mental Health and
Addiction Services, Wellington,
New Zealand.
Sarah E. Romans is a Professor
at the Department of
Psychological Medicine,
University of Otago, Wellington,
New Zealand.
DOI 10.1108/JFP-03-2017-0007 VOL. 19 NO. 4 2017, pp. 269-277, © Emerald Publishing Limited, ISSN 2050-8794
j
JOURNAL OF FORENSIC PRACTICE
j
PAG E 26 9

To continue reading

Request your trial

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT